CAJ | 학술논문

目的比较基于4D-CT 10个呼吸时相所构建非小细胞肺癌(NSCLC)内大体肿瘤体积(IGTV10)与基于18F-FDG PET-CT不同SUV值勾画所得靶区(IGTVPET)间体积及位置差异.方法 10例NSCLC患者序贯完成胸部3D-CT、4D-CT增强扫描,并基于相同体位固定方式及定位参数行18F-FDG PET-CT扫描.在4D-CT 10个呼吸时相图像上勾画原发肿瘤大体肿瘤体积(GTV)并融合获得IGTV10.基于PET图像不同SUV值(≥1.5、≥2.0、≥2.5、≥3.0)、最大SUV值的不同百分比(≥20％、≥25％、≥30％、≥35％、≥40％)及目测法勾画原发肿瘤靶区(IGTVPET),比较IGTVPET与IGTV10靶区间位置、体积大小、包含度(DI)和适形指数(CI)差异.结果除IGTVPET15外,其余IGTVPET与IGTV10中心点坐标在上下方向差异均有统计学意义(Z=-2.703～-2.293,P＜0.05).IGTVPET22.0与IGTV10体积大小最接近,其次是IGTVPET20％,二者同IGTV10体积比间差异无统计学意义(Z=-0.415,P＞0.05).IGTV10对IGTV PET1.5的DI高于IGTV10对其余IGTVPET的DI(Z=-2.803～-2.429,P＜0.05).IGTVPET2.0与IGTV10的CI最高,高于IGTVPET5％、IGTVPET40％、IGTV PET2.5、IGTVPET3.0与IGTV10的CI(Z=-2.803 ～-2.191,P＜0.05).结论基于PET SUV值≥2.0及SUVmax的百分比≥20％勾画所得的IGTVPET2.0、IGTVPET20％与基于4D-CT 10个时相GTV构建的IGTV10体积大小较为相近,但IGTVPET2.0、IGTVPET20％与IGTV10间空间错位较明显,二者均不能代替IGTV10.
목적 비교기우4D-CT 10개호흡시상소구건비소세포폐암(NSCLC)내대체종류체적(IGTV10)여기우18F-FDG PET-CT불동SUV치구화소득파구(IGTVPET)간체적급위치차이.방법 10례NSCLC환자서관완성흉부3D-CT、4D-CT증강소묘,병기우상동체위고정방식급정위삼수행18F-FDG PET-CT소묘.재4D-CT 10개호흡시상도상상구화원발종류대체종류체적(GTV)병융합획득IGTV10.기우PET도상불동SUV치(≥1.5、≥2.0、≥2.5、≥3.0)、최대SUV치적불동백분비(≥20％、≥25％、≥30％、≥35％、≥40％)급목측법구화원발종류파구(IGTVPET),비교IGTVPET여IGTV10파구간위치、체적대소、포함도(DI)화괄형지수(CI)차이.결과 제IGTVPET15외,기여IGTVPET여IGTV10중심점좌표재상하방향차이균유통계학의의(Z=-2.703～-2.293,P＜0.05).IGTVPET22.0여IGTV10체적대소최접근,기차시IGTVPET20％,이자동IGTV10체적비간차이무통계학의의(Z=-0.415,P＞0.05).IGTV10대IGTV PET1.5적DI고우IGTV10대기여IGTVPET적DI(Z=-2.803～-2.429,P＜0.05).IGTVPET2.0여IGTV10적CI최고,고우IGTVPET5％、IGTVPET40％、IGTV PET2.5、IGTVPET3.0여IGTV10적CI(Z=-2.803 ～-2.191,P＜0.05).결론 기우PET SUV치≥2.0급SUVmax적백분비≥20％구화소득적IGTVPET2.0、IGTVPET20％여기우4D-CT 10개시상GTV구건적IGTV10체적대소교위상근,단IGTVPET2.0、IGTVPET20％여IGTV10간공간착위교명현,이자균불능대체IGTV10.
Objective To compare the positional and volumetric differences of internal gross target volumes (IGTVs) delineation based on four-dimensional CT (4D-CT) images and different standardized uptake values of 18F-fluorodeoxyglucose positron emission tomography CT (PET-CT) for the primary non-small cell lung cancer (NSCLC).Methods Ten NSCLC patients underwent enhanced three-dimensional CT scan followed by enhanced 4D-CT scan of the thorax under normal free breathing and then 18F-FDG PET-CT scan was performed based on the same position and positioning parameters.The gross target volumes (GTVs) of 10 phases of 4D-CT were contoured and IGTV10 was obtained by fusion of the 10 GTVs.IGTVPET were determined with nine different threshold methods using the auto-contouring function and manual contouring.The differences of position,volume,degree of inclusion (DI) and conformity index (CI) between IGTVPET and IGTV10 were compared.Results For superior-inferior (SI) directions,there were statistically significant differences between the centric coordinate parameters of IGTVPET(excluding IGTVPET1.5) and IGTV10 (Z =-2.703--2.293,P ＜ 0.05).In volume terms,IGTVPET2.0 was approximated close to IGTV10 with median volume ratios of 0.90,followed by IGTVPET20％ to IGTV10 with median volume ratios of 0.84,but there was no significant difference between them.The DI of IGTVPET1.5 in IGTV10 was higher than the DIs of other IGTVPET in IGTV10 (Z =-2.803--2.429,P ＜ 0.05).The CI of IGTVPE2.0 and IGTV10 was superior than the CIs of IGTVPET35％ and IGTV10,IGTVPET40％ and IGTV10,IGTVPET2.5 and IGTV10,IGTVPET3.0 and IGTV10 (Z =-2.803--2.191,P ＜ 0.05).Conclusions The IGTVPET contoured by SUV≥2.0 or 20％ of the maximal SUV are approximate close to IGTV10 in target size,but the extent of spatial mismatch is relatively obvious between them.So neither IGTVPET20％ nor IGTVPET2.0 could replace IGTV10.